UBC Reports | Vol.
50 | No. 10 | Nov.
All Alone: Too Many Mothers Give Birth Miles from Home
By Hilary Thomson
For thousands of B.C. women, having a baby has meant leaving
home and family, travelling hundreds of kilometres, and sitting
in a motel room for days or weeks waiting for labour to start.
This bleak scenario is one that UBC Faculty of Medicine
investigators Stefan Grzybowski and Jude Kornelsen will explore
through a series of studies that looks at rural maternal care
services, funded by a $1.4-million, five-year grant from the
Canadian Institutes of Health Research (CIHR).
It is the most comprehensive program of research being undertaken
on rural maternity care in Canada.
When women are forced to deliver away from home it can lead
to serious health and social costs for mothers and their families
as well as strain on the health-care system, says Grzybowski,
director of research in the Dept. of Family Practice.
“The needs of rural women are not being met -- it’s
just not good enough,” he says.
The program of research will bring together a team of maternal
care researchers that includes sociologists and economists
as well as physicians and community-based investigators. It
will focus on seven key areas including health outcomes of
mothers and babies from rural areas and how hospitals receiving
these patients manage the additional strain on resources.
The team will also compare costs of maternal care within and
outside home communities.
Studies in the U.S. have shown that delivery outside the
home community is connected to an increase in infant deaths
and the need for babies to be placed in special care nurseries.
“Decisions are being made at a policy level without
all the necessary information,” says Kornelsen, clinical
assistant professor in the Dept. of Family Practice. “Surprisingly,
there has been no representation of women’s voices in
the literature on this subject.”
The team will draw information from existing data sources
as well as interviews with community members. Researchers
have visited communities from Merritt in B.C.’s Interior
to Telegraph Creek in the province’s far north, working
with public health nurses and other care providers.
About 2,000 of B.C.’s annual total of 40,000 babies
are born to mothers who live in small rural communities. For
a variety of reasons, ranging from centralization of services
to difficulties recruiting and retaining maternity care providers,
rural services have been gradually eroding in these communities.
Since 2000, 13 B.C. communities have stopped offering local
For example, women from the northern community of Dease
Lake must travel for nine hours (longer in winter) to get
to Terrace to have their baby. Because projected due dates
are not always accurate, women are advised to leave home weeks
in advance of the birth to ensure they will have care when
they need it.
Kornelsen says the stress is significant. There is anxiety
about being alone in a strange place for an indeterminate
period and being treated by an unfamiliar doctor. In addition,
there is the financial burden of accommodation, food and long-distance
phone bills. There may also be concerns about finding and
paying for childcare for children left at home. Some mothers
bring their children with them because there is no care for
them at home.
Fewer than half the mothers are able to stay with friends
or family in the communities they are referred to, estimates
Although most aboriginal women have costs subsidized by
their band, they are often hit hardest by the social disruption,
“These women may be first-time mothers who have never
been away from home and rely on strong family and community
support. It can be a frightening situation for them.”
For some, moving away to have a baby is just not feasible.
They remain in the community until delivery and hope a general
practitioner can handle any complications. Some women take
the risk of an unassisted home birth.
Part of the problem is the increasing difficulty in finding
general practitioners willing to provide maternity services
in small communities, says Grzybowski, who is also an investigator
at the Children’s & Women’s Health Centre
of B.C. There is also a general shortage of obstetricians
and gynecologists in Canada and a particular shortage in rural
communities that serve as referral centres. The whole system
is breaking down, he says.
The problem calls for sustainable solutions, he says, and
points to Norway’s system of rural maternity units staffed
by midwives as a possibility. He and Kornelsen hope their
research will trigger increased awareness of the problems
faced by rural women who are soon to give birth.
Children’s & Women’s Health Centre of British
Columbia is an agency of the Provincial Health Services Authority,
and includes BC Children’s Hospital and Sunny Hill Health
Centre for Children, and BC Women’s Hospital & Health